Pledge of Life Insurance Proceeds to Creditor


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									This is a pledge between a lender and a borrower, which is used in connection with an
agreement to lend money. This pledge provides that the borrower's life insurance
proceeds will be collateral for the loan, thus if the borrower dies with unpaid principal or
interest, the lender can collect the remainder out of the borrower's life insurance
proceeds. The document sets forth the material terms and conditions of the agreement
including the loan amount, the life insurance policy number, and the policy's face value.
It may be customized to address the specific needs of the parties. This document
should be used by lenders and borrowers when using a life insurance policy as
collateral for the loan.

THIS PLEDGE OF LIFE INSURANCE PROCEEDS (the “Pledge”) made as of ___________
[Instruction: Insert Date], by and between ___________ [Instruction: Insert Name of
Lender], ___________ [Instruction: Insert Address] (“Pledgee”), and ___________
[Instruction: Insert Name of Borrower], ___________ [Instruction: Insert Address]

WHEREAS, contemporaneous herewith, Pledgee and Pledgor have entered into an agreement
(the “Agreement”), and pursuant to the terms thereof, Pledgee made a loan to Pledgor in the
amount of ___________ Dollars ($______) [Instruction: Insert Amount] (the “Loan”); and

WHEREAS, the Agreement provides that Pledgor will pledge the proceeds of his life insurance
to Pledgee as collateral for the Loan and will execute this Pledge to give effect to the foregoing.

NOW, THEREFORE, in consideration of the mutual promises and covenants hereinafter set
forth, the parties agree as follows:

1. Pledge. As collateral for the Loan, to the extent of the principal and interest due upon the
Loan, and any renewals and extensions of the Loan, Pledgor hereby assigns to Pledgee any and
all proceeds from the following life insurance policy (the “Life Insurance Policy”)

   A. Policy number: ___________ [Instruction: Insert Policy Number]

   B. Face amount: ___________ Dollars ($______) [Instruction: Insert Amount]

   C. Loans and/or charges against policy: ___________ Dollars ($______) [Instruction:
      Insert Amount]

2. Further Assurances. Upon request by Pledgee, Pledgor shall execute and deliver such further
instruments and take such further actions as may be necessary to evidence more fully the pledge
to Pledgee of the proceeds of the Life Insurance Policy.

3. Miscellaneous.

    A. This Pledge constitutes the entire agreement between the parties hereto with respect to
the specific subject matter hereof and supersedes all prior agreements or understandings of any
kind with respect to the specific subject matter hereof.

   B. Any modification to this Pledge must be in writing and signed by the parties or it shall
have no effect and shall be void.

    C. This Pledge is binding upon and shall inure to the benefit of the respective successors,
licensees and/or assigns of the parties hereto.
    D. This Pledge shall be governed in accordance with the laws of the State of
_____________ [Instruction: Insert State], applicable to agreements to be wholly performed
therein, with jurisdiction exclusive to the Federal and State courts located in the County of
_____________ [Instruction: Insert County], State of ______________ [Instruction: Insert

IN WITNESS WHEREOF the parties have duly executed this Pledge as of the date first written


________________________________ [Instruction: sign]
___________________________ [Instruction: Insert Name of Signatory]


________________________________ [Instruction: sign]
By: ___________________________ [Instruction: Insert Name of Signatory]
Title: ___________________________ [Instruction: Insert Title of                  Signatory]

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